Provider Demographics
NPI:1295496685
Name:ELITE PRIMARY CARE LLC
Entity type:Organization
Organization Name:ELITE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-993-9890
Mailing Address - Street 1:PO BOX 2845
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-2845
Mailing Address - Country:US
Mailing Address - Phone:575-303-2929
Mailing Address - Fax:575-233-6260
Practice Address - Street 1:1401 S DON ROSER DR STE F1
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4577
Practice Address - Country:US
Practice Address - Phone:575-303-2929
Practice Address - Fax:575-233-6260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE PRIMARY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment